Behaviors Indicative of Pain in Brain-Injured Adult Patients With Different Levels of Consciousness in the Intensive Care Unit
Many brain-injured patients are unable to self-report their pain during their hospitalization in the intensive care unit (ICU), and existing behavioral pain scales may not be well suited. The objectives of this study were to describe and compare behaviors in brain-injured patients with different lev...
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| Veröffentlicht in: | Journal of pain and symptom management 2019-04, Vol.57 (4), p.761-773 |
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| container_title | Journal of pain and symptom management |
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| creator | Gélinas, Céline Boitor, Madalina Puntillo, Kathleen A. Arbour, Caroline Topolovec-Vranic, Jane Cusimano, Michael D. Choinière, Manon Streiner, David L. |
| description | Many brain-injured patients are unable to self-report their pain during their hospitalization in the intensive care unit (ICU), and existing behavioral pain scales may not be well suited.
The objectives of this study were to describe and compare behaviors in brain-injured patients with different levels of consciousness during nociceptive and nonnociceptive care procedures in the ICU and to examine interrater agreement of individual behaviors as well as discriminative and criterion validation of putative pain behaviors.
Brain-injured ICU patients were observed using a 40-item behavioral checklist before and during soft touch (i.e., nonnociceptive procedure), turning, and other care procedures (nociceptive) by pairs of trained raters. When possible, patients self-reported their pain on a 0–10 visual thermometer. Patients were classified into unconscious (Glasgow Coma Scale, 3 |
| doi_str_mv | 10.1016/j.jpainsymman.2018.12.333 |
| format | Article |
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The objectives of this study were to describe and compare behaviors in brain-injured patients with different levels of consciousness during nociceptive and nonnociceptive care procedures in the ICU and to examine interrater agreement of individual behaviors as well as discriminative and criterion validation of putative pain behaviors.
Brain-injured ICU patients were observed using a 40-item behavioral checklist before and during soft touch (i.e., nonnociceptive procedure), turning, and other care procedures (nociceptive) by pairs of trained raters. When possible, patients self-reported their pain on a 0–10 visual thermometer. Patients were classified into unconscious (Glasgow Coma Scale, 3<GCS≤8), altered consciousness (9≤GCS≤12), or conscious (13≤GCS≤15).
A sample of 147 patients participated (65 conscious, 56 altered consciousness, and 26 unconscious). Active behaviors (e.g., face expressions and body movements) were more frequent in conscious patients. High-percentage interrater agreement (80%–98%) was obtained for most behaviors. The total number of active behaviors was significantly higher during turning and other nociceptive procedures compared with rest (Wilcoxon = 9.873, P < 0.001) and soft touch (Wilcoxon = 9.486, P < 0.001) regardless of levels of consciousness. The strongest predictors of pain intensity (n = 33) were grimace, mouth opening, orbit tightening, eye weeping, and eyes tightly closed; these behaviors were moderately correlated with self-reported pain intensity (Spearman rho = 0.47).
These findings may guide the revision of existing pain scales to make their content more suited for this population.</description><identifier>ISSN: 0885-3924</identifier><identifier>EISSN: 1873-6513</identifier><identifier>DOI: 10.1016/j.jpainsymman.2018.12.333</identifier><identifier>PMID: 30593909</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>assessment ; Behavior ; behaviors ; Body movement ; Brain injuries ; brain-injured ; Coma ; Consciousness ; critical care ; Crying ; Hospitalization ; Intensive care ; Mouth ; Nonverbal communication ; Pain ; Patient assessment ; Physical activity ; Self report ; Unconsciousness ; Validity</subject><ispartof>Journal of pain and symptom management, 2019-04, Vol.57 (4), p.761-773</ispartof><rights>2018 American Academy of Hospice and Palliative Medicine</rights><rights>Copyright © 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Apr 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c456t-a0f6abf739af8605a892fbd58678161f6041156f032c95ba4fc4779d2e4e9bd3</citedby><cites>FETCH-LOGICAL-c456t-a0f6abf739af8605a892fbd58678161f6041156f032c95ba4fc4779d2e4e9bd3</cites><orcidid>0000-0001-7695-4212</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0885392418314817$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,30978,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30593909$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gélinas, Céline</creatorcontrib><creatorcontrib>Boitor, Madalina</creatorcontrib><creatorcontrib>Puntillo, Kathleen A.</creatorcontrib><creatorcontrib>Arbour, Caroline</creatorcontrib><creatorcontrib>Topolovec-Vranic, Jane</creatorcontrib><creatorcontrib>Cusimano, Michael D.</creatorcontrib><creatorcontrib>Choinière, Manon</creatorcontrib><creatorcontrib>Streiner, David L.</creatorcontrib><title>Behaviors Indicative of Pain in Brain-Injured Adult Patients With Different Levels of Consciousness in the Intensive Care Unit</title><title>Journal of pain and symptom management</title><addtitle>J Pain Symptom Manage</addtitle><description>Many brain-injured patients are unable to self-report their pain during their hospitalization in the intensive care unit (ICU), and existing behavioral pain scales may not be well suited.
The objectives of this study were to describe and compare behaviors in brain-injured patients with different levels of consciousness during nociceptive and nonnociceptive care procedures in the ICU and to examine interrater agreement of individual behaviors as well as discriminative and criterion validation of putative pain behaviors.
Brain-injured ICU patients were observed using a 40-item behavioral checklist before and during soft touch (i.e., nonnociceptive procedure), turning, and other care procedures (nociceptive) by pairs of trained raters. When possible, patients self-reported their pain on a 0–10 visual thermometer. Patients were classified into unconscious (Glasgow Coma Scale, 3<GCS≤8), altered consciousness (9≤GCS≤12), or conscious (13≤GCS≤15).
A sample of 147 patients participated (65 conscious, 56 altered consciousness, and 26 unconscious). Active behaviors (e.g., face expressions and body movements) were more frequent in conscious patients. High-percentage interrater agreement (80%–98%) was obtained for most behaviors. The total number of active behaviors was significantly higher during turning and other nociceptive procedures compared with rest (Wilcoxon = 9.873, P < 0.001) and soft touch (Wilcoxon = 9.486, P < 0.001) regardless of levels of consciousness. The strongest predictors of pain intensity (n = 33) were grimace, mouth opening, orbit tightening, eye weeping, and eyes tightly closed; these behaviors were moderately correlated with self-reported pain intensity (Spearman rho = 0.47).
These findings may guide the revision of existing pain scales to make their content more suited for this population.</description><subject>assessment</subject><subject>Behavior</subject><subject>behaviors</subject><subject>Body movement</subject><subject>Brain injuries</subject><subject>brain-injured</subject><subject>Coma</subject><subject>Consciousness</subject><subject>critical care</subject><subject>Crying</subject><subject>Hospitalization</subject><subject>Intensive care</subject><subject>Mouth</subject><subject>Nonverbal communication</subject><subject>Pain</subject><subject>Patient assessment</subject><subject>Physical activity</subject><subject>Self report</subject><subject>Unconsciousness</subject><subject>Validity</subject><issn>0885-3924</issn><issn>1873-6513</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>7QJ</sourceid><recordid>eNqNkU2L1TAUhoMoznX0L0jEjZvWfDRps5zp-HHhgi5GXIa0PeGmtOk1SS_Mxt9uyh1FXBkCSchz3vdwXoTeUFJSQuX7sRxPxvn4MM_Gl4zQpqSs5Jw_QTva1LyQgvKnaEeaRhRcseoKvYhxJIQILvlzdMWJUFwRtUM_b-Fozm4JEe_94HqT3BnwYvHXbIDzvg35Uuz9uAYY8M2wTin_JQc-RfzdpSO-c9ZCyG98gDNMcatuFx97t6zRQ4ybTDpCNkjg46bfmgD4m3fpJXpmzRTh1eN5je4_frhvPxeHL5_27c2h6CshU2GIlaazNVfGNpII0yhmu0E0sm6opFaSilIhLeGsV6Izle2rulYDgwpUN_Br9O4iewrLjxVi0rOLPUyT8ZCb1CyLSKVIU2X07T_ouKzB5-Y0y0tRRQXPlLpQfVhiDGD1KbjZhAdNid4y0qP-KyO9ZaQp0zmjXPv60WHtZhj-VP4OJQPtBcjDhLODoPMswfcwuAB90sPi_sPmF8b0qVU</recordid><startdate>201904</startdate><enddate>201904</enddate><creator>Gélinas, Céline</creator><creator>Boitor, Madalina</creator><creator>Puntillo, Kathleen A.</creator><creator>Arbour, Caroline</creator><creator>Topolovec-Vranic, Jane</creator><creator>Cusimano, Michael D.</creator><creator>Choinière, Manon</creator><creator>Streiner, David L.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7695-4212</orcidid></search><sort><creationdate>201904</creationdate><title>Behaviors Indicative of Pain in Brain-Injured Adult Patients With Different Levels of Consciousness in the Intensive Care Unit</title><author>Gélinas, Céline ; Boitor, Madalina ; Puntillo, Kathleen A. ; Arbour, Caroline ; Topolovec-Vranic, Jane ; Cusimano, Michael D. ; Choinière, Manon ; Streiner, David L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c456t-a0f6abf739af8605a892fbd58678161f6041156f032c95ba4fc4779d2e4e9bd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>assessment</topic><topic>Behavior</topic><topic>behaviors</topic><topic>Body movement</topic><topic>Brain injuries</topic><topic>brain-injured</topic><topic>Coma</topic><topic>Consciousness</topic><topic>critical care</topic><topic>Crying</topic><topic>Hospitalization</topic><topic>Intensive care</topic><topic>Mouth</topic><topic>Nonverbal communication</topic><topic>Pain</topic><topic>Patient assessment</topic><topic>Physical activity</topic><topic>Self report</topic><topic>Unconsciousness</topic><topic>Validity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gélinas, Céline</creatorcontrib><creatorcontrib>Boitor, Madalina</creatorcontrib><creatorcontrib>Puntillo, Kathleen A.</creatorcontrib><creatorcontrib>Arbour, Caroline</creatorcontrib><creatorcontrib>Topolovec-Vranic, Jane</creatorcontrib><creatorcontrib>Cusimano, Michael D.</creatorcontrib><creatorcontrib>Choinière, Manon</creatorcontrib><creatorcontrib>Streiner, David L.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of pain and symptom management</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gélinas, Céline</au><au>Boitor, Madalina</au><au>Puntillo, Kathleen A.</au><au>Arbour, Caroline</au><au>Topolovec-Vranic, Jane</au><au>Cusimano, Michael D.</au><au>Choinière, Manon</au><au>Streiner, David L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Behaviors Indicative of Pain in Brain-Injured Adult Patients With Different Levels of Consciousness in the Intensive Care Unit</atitle><jtitle>Journal of pain and symptom management</jtitle><addtitle>J Pain Symptom Manage</addtitle><date>2019-04</date><risdate>2019</risdate><volume>57</volume><issue>4</issue><spage>761</spage><epage>773</epage><pages>761-773</pages><issn>0885-3924</issn><eissn>1873-6513</eissn><abstract>Many brain-injured patients are unable to self-report their pain during their hospitalization in the intensive care unit (ICU), and existing behavioral pain scales may not be well suited.
The objectives of this study were to describe and compare behaviors in brain-injured patients with different levels of consciousness during nociceptive and nonnociceptive care procedures in the ICU and to examine interrater agreement of individual behaviors as well as discriminative and criterion validation of putative pain behaviors.
Brain-injured ICU patients were observed using a 40-item behavioral checklist before and during soft touch (i.e., nonnociceptive procedure), turning, and other care procedures (nociceptive) by pairs of trained raters. When possible, patients self-reported their pain on a 0–10 visual thermometer. Patients were classified into unconscious (Glasgow Coma Scale, 3<GCS≤8), altered consciousness (9≤GCS≤12), or conscious (13≤GCS≤15).
A sample of 147 patients participated (65 conscious, 56 altered consciousness, and 26 unconscious). Active behaviors (e.g., face expressions and body movements) were more frequent in conscious patients. High-percentage interrater agreement (80%–98%) was obtained for most behaviors. The total number of active behaviors was significantly higher during turning and other nociceptive procedures compared with rest (Wilcoxon = 9.873, P < 0.001) and soft touch (Wilcoxon = 9.486, P < 0.001) regardless of levels of consciousness. The strongest predictors of pain intensity (n = 33) were grimace, mouth opening, orbit tightening, eye weeping, and eyes tightly closed; these behaviors were moderately correlated with self-reported pain intensity (Spearman rho = 0.47).
These findings may guide the revision of existing pain scales to make their content more suited for this population.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30593909</pmid><doi>10.1016/j.jpainsymman.2018.12.333</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0001-7695-4212</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Elsevier ScienceDirect Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Applied Social Sciences Index & Abstracts (ASSIA) |
| subjects | assessment Behavior behaviors Body movement Brain injuries brain-injured Coma Consciousness critical care Crying Hospitalization Intensive care Mouth Nonverbal communication Pain Patient assessment Physical activity Self report Unconsciousness Validity |
| title | Behaviors Indicative of Pain in Brain-Injured Adult Patients With Different Levels of Consciousness in the Intensive Care Unit |
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